Since the initial release the ap drgs have been

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Since the initial release, the AP-DRGs have been updated every one to two years. The treatment of trauma patients has become highly specialized. Selected hospitals are often designated as trauma centers. Because of the high degree of specialization, it is particularly important that the AP-DRGs identify the different types of multiple trauma patients. MDC 25 was added to the AP-DRGs for multiple trauma patients. All trauma diagnoses were reviewed and divided into eight body site categories (head, chest, abdomen, kidney, urinary, pelvis and spine, lower limb, and upper limb). Within each body site, the traumas that were considered significant were identified (e.g., in the chest body site, a flail chest is a significant trauma while a single frac- tured rib is not). Patients are assigned to the multiple trauma MDC if they have at least two significant trauma diagnoses (as either principal or secondary) from different body sites. The mul- tiple trauma MDC is divided based on the presence of an operating room procedure. Medical and surgical patients with major nontraumatic complications or comorbidities are assigned to sepa- rate AP-DRGs. There are five OR procedure AP-DRGs and three medical AP-DRGs in the multiple trauma MDC. Based on New York cost data, a patient assigned to the multiple trauma MDC will cost on average twice as much as trauma patients who do not have multiple traumas. MDC 20 (Alcohol/Drug Use & Alcohol/Drug Induced Organic Mental Disorders) for alcohol and drug abuse was also completely restructured. Patients were differentiated based on the sub- stance being abused:
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14 Opioid abuse Alcohol abuse Cocaine and other drug abuse Each category of substance abuse was then further subdivided based on whether the patient left against medical advice, and the presence of complications and comorbidities. There are a total of nine AP-DRGs in MDC 20. Patients who are on long-term mechanical ventilation are extremely expensive. Long-term ventilation patients require that a tracheostomy be performed. Across all MDCs, patients with a tracheostomy were put into one of two tracheostomy AP-DRGs. Patients with certain mouth, larynx, or pharynx diseases are not patients on long-term ventilation support, but are patients who are having the tracheostomy performed for therapeutic reasons as treatment for the mouth, larynx, or pharynx problem. These patients are assigned a separate AP-DRG while all other patients with a tracheostomy represent long-term ventilation patients and are assigned to a differ- ent AP-DRG. Liver transplants, bone marrow transplants, heart transplants, kidney transplants, and lung trans- plants are very expensive and can be performed for diagnoses in different MDCs (e.g., a liver transplant can be performed for certain poisonings as well as for certain liver diseases). All liver, bone marrow, heart, kidney, lung and simultaneous kidney/pancreas transplant patients are assigned to an AP-DRG independent of the MDC of the principal diagnosis.
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  • Fall '18
  • Diagnosis-related group, DRGs

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